Memory is the cognitive process of acquiring, storing and retrieving information. It's the mind's ability to encode, store and recall experiences and knowledge, allowing for learning, adaptation, and the formation of personal identity. There are different types of memory, including short-term memory, where information is held briefly and long-term memory, where information is held for extended periods. There is sensory memory where information relating to senses such as sight, sound and smell are retained, explicit memory recalling memories or facts and events and implicit memory that influences our behaviour without conscious awareness; for example, like riding a bike or driving your car.

Memory storage involves multiple brain regions, but the hippocampus is crucial for forming new memories, especially long-term memories and acts as a gateway for encoding and consolidating memories. The cerebral cortex and prefrontal cortex also participate in memory storage and retrieval.

Without memory, our enjoyment of life’s wonderful pleasures and diversity is severely compromised. Unfortunately, memory loss is also a key feature of dementia and is often cited as an early clinical marker of cognitive decline in a patient who is starting to have difficulty coping with the complexity of life, their medication schedule, shopping lists and daily tasks.

I was curious to understand how we may improve and maintain our own memories whilst also providing advice in terms of exercises that may benefit our patients coping with early cognitive decline. The history of memory recall starts in Greece with Simonides of Ceos in ~500 BC. Simonides is credited with developing the ‘method of loci’ or ‘room method ‘of memory recall after an earthquake collapsed the roof at a banquet he had just attended, killing all inside. Relying on his visual memory, he was able to accurately identify the corpses by precisely recalling their seating arrangements as he had noticed them while he was reciting poetry to the guests. This method, now popularised by many teaching memory techniques, highlights the value of linking things we need to remember together to enhance their recall. It is also interesting that memory for music and songs is often retained until late in cognitive decline.

In an attempt to explore the ideas behind the complex subject of memory in more detail, it was an honour to have Dr Natalie Grima accept an invitation for the podcast. Natalie is a clinical neuropsychologist based in Melbourne and the founder of Neuro Psychological Counselling Australia. She is a senior clinical neuropsychologist at Monash Health and has published widely, completing her doctorate at Monash University and undertaking advanced clinical training at Harvard Medical School. Natalie has a special interest in the diagnosis of dementia, psychiatric conditions and cognitive rehabilitation following acquired brain injuries. She also has an expert knowledge on the subject of memory. Please welcome her to the podcast.

References:

Dr Natalie Grima: www.neuropychconsulting.com.au

https://mocacognition.com/

Simonides of Ceos-Wikipedia

Obesity has reached crisis levels in Australia, with 67% of Australians classified as being overweight or obese (2022 data). BMI measurements have been used in epidemiological studies to define overweight individuals with a measurement of 25 kilograms per metre squared and obese individuals with a BMI measurement of more than 30 kilograms per metre squared. It is now recognised, however, that BMI-based measures of obesity may both underestimate or overestimate adiposity and provide inadequate information about health at the individual level and subsequently undermine medically sound approaches to healthcare and policy. A recent Commission of 58 experts in this field reported a consensus in The Lancet defining obesity as "a condition characterised by excess adiposity, with or without abnormal distribution or function of adipose tissue and with causes that are multifactorial and still incompletely understood". They subsequently teased out the diagnosis of obesity to include preclinical and clinical definitions, where:

Pre-clinical obesity is defined by excess fat accumulation as measured by direct means with DEXA or indirect anthropometric measurements such as waist to height, waist circumference or waist to hip ratio measurement. This group of patients have no clinical disease or end-organ damage or symptoms as yet, but an increased risk of developing clinical obesity and conditions such as type 2 diabetes, cardiovascular disease and some neoplasms. The treatment focus in this group includes counselling and the introduction of measures to prevent progression to the next subgroup, which is clinical obesity.

Clinical Obesity is defined as a chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications. The main focus of management for this cohort is to improve end-organ dysfunction as a priority rather than to focus on weight loss alone. Treatment options include lifestyle modification through diet and counselling, and rely on established pharmacology such as GLP-1 receptor agonists, which are likely to be used as a long-term treatment strategy. For a select number of patients, however, these medications can induce nausea, vomiting, diarrhoea, constipation and reflux. In more serious cases gastro paresis and pancreatitis are described. Non-responsiveness and high cost may be a limiting factor amongst some patients. Consequently, surgery remains the cornerstone for safely and effectively managing obesity and includes both gastric sleeve and bypass operations.

To discuss this new definition of obesity and approach to thinking about obesity, as well as to review surgical options, I was curious to open a discussion with Dr Melissa Beitner. Melissa is a fellow of The Royal Australasian College of Surgeons; she is American Board of Surgery certified, a fellow of the American Society of Metabolic and Bariatric Surgery and is a diplomat of the American Board of Obesity Medicine. Melissa is incredibly well credentialed, having undertaken bariatric surgery fellowships at Mount Sinai Hospital in New York, Royal Brisbane and Women's Hospital and St. George Hospital, Sydney. She has special areas of interest in bariatric surgery and obesity medicine, and is also highly skilled in hiatus hernia and anti-reflux surgery, cholecystectomy and general surgical removal of lumps and bumps. Please welcome Meissa to the podcast.

References: 

Dr Beitner, Weight Loss Solutions: www.360surgery.com.au

Definition and Diagnostic Criteria of Clinical Obesity, F Rubino et al. The Lancet Diabetes and Endocrinology Commission. Vol 13, Issue 3, P221-262, March 2025

Artificial intelligence is a wide-ranging branch of computer science concerned with building smart machines capable of performing tasks that typically require human intelligence. It is widely accepted that artificial intelligence computer systems will be used extensively in Medical Sciences. Common applications are likely to include illness diagnosis, end-to-end drug discovery and development, improving communication between physicians and patients, transcribing medical documents, including history note taking and writing prescriptions. It is probable that as technology advances, doctors and allied health professionals will be replaced in certain roles by artificial intelligence computers. 

Artificial intelligence is not new and has been an important enabler within the technology industry, built into our handheld phone computer devices, enabling new business innovation, including web search content recommendations, product recommendations, targeted advertising and autonomously driven vehicles. Humans reap the benefits of artificial intelligence systems every day.

In medical practice, there are many advantages offered from embracing artificial intelligence, with the expectation that diagnostic accuracy and patient care will be the beneficiaries, whilst providing an excellent second opinion or co-collaborator with the physician, increasing medical efficiency and confidence in applying treatment strategies.

I was curious to learn more about the likely trends this technology might bring to health management and was fortunate to meet Anders Sorman- Nilsson at a recent medical conference where he provided our audience with a thought-provoking, entertaining and informative lecture on the future, including the possible integration of AI in medicine. As a global futurist and innovative strategist, Anders gave us a wonderful glimpse into a new world.

Anders has degrees in both law and political science as well as an EMBA, has keynoted at TED X in the United States and Australia and shared the stage with Hillary Clinton. He was nominated to the World Economic Forum's young global leaders in 2015 and has authored 3 books, including Seamless, Thinque Funky and Digilogue, as well as contributing to After Shock, edited by John Schroeter. Noting how meticulously researched and energetic his lecture was at our conference, I could strongly recommend Anders to anyone seeking an excellent keynote speaker who will provoke searching questions and prompt some deep thinking, possibly inspiring a new and creative approach to how you conduct business and prepare for the future. 

In this podcast, I was keen to explore the possible place of artificial intelligence in medicine, including how it could impact diagnostic assistance, drug discovery, provide virtual health assistance, enhance personalised medicine, as well as improve robot-assisted surgery. Other areas of interest extend to its place in influencing medical education and training, clinical trial optimisation, natural language processing for health records and how it may assist in both the sequencing of genomes and coping strategies for those requiring mental health support. It was a great privilege to speak to Anders today. Please welcome him to the podcast.

References: 

Anders Sorman-Nilsson found at: anderssorman-nilsson.com

Artificial Intelligence: How is it Changing Medical Science and Its Future? Basu et al.  https://www.ncbi.nlm.nih.gov

The Guillain Barre syndrome is an acute inflammatory demyelinating polyradiculopathy and although relatively rare (0.4-2 per 100,000) it is still the most common cause of acute flaccid neuromuscular paralysis worldwide. It famously affected Joseph Heller author of Catch-22 and more recently AFL football Legend Alexander Clarkson. It is an immune-mediated disorder that affects the peripheral nervous system and is another example of molecular mimicry, occurring 1 to 6 weeks after a respiratory infection, Campylobacter enterocolitis, and rarely after trauma or surgery. In 1 in a million cases, GB may develop after the influenza vaccine.

Myasthenia gravis is an autoimmune disorder most commonly observed in women under the age of 40 years and in men over the age of 60 years where antibodies form against the nicotinic acetylcholine receptor at the neuromuscular junction (85% of cases), muscle-specific tyrosine kinase (MuSK 7-10%) or low-density lipoprotein receptor-related protein 4 (LRP 4-5%)-the MuSK 7 and LRP4 are both important to the health of the neuromuscular junction. MG results in muscle fatigue especially of the eyes, facial muscles and bulbar muscles.

To discuss these two interesting conditions we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has major clinical expertise in the management of both acute and chronic neurological conditions, please join me in this conversation with Ernie.

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Multiple sclerosis is an autoimmune neurodegenerative disease of the brain and spinal cord resulting in CNS demyelination affecting 2.8 million people worldwide and 23,000 Australians. There are about 1000 new cases diagnosed in Australia each year and the accumulation of disability can be devastating with an estimated 50 to 80% of patients ceasing full-time work within 10 years. The condition is 3 times more common in women and is most often seen between the ages of 20 and 40 years. The damage in multiple sclerosis is caused by a type IV hypersensitivity reaction and may reflect molecular mimicry with activated T cells crossing the blood-brain barrier and attacking CNS myelin which is produced by oligodendrocytes (myelin in the peripheral nervous system is made by Schwann cells).

Environmental and genetic factors play a role in the aetiology with a higher incidence of multiple sclerosis identified in patients living north of 40 degrees (north of Beijing and including much of Europe Russia the northern parts of the United States and Canada) or South of 40 degrees (Tasmania) raising speculation about the role of ultraviolet light and vitamin D. MS is 15 times more likely when a 1st-degree relative is affected and concordance with monozygotic twins is about 25%. Obesity, smoking, high intake of dietary saturated fats and Epstein-Barr virus have also been implicated.

Despite the distressing nature of this neurodegenerative condition many treatments are evolving to manage both acute episodes (steroids, plasmapheresis) and to prevent further damage (from Interferon beta and Glatiramer acetate to Ocrelizumab, Natalizumab and Stem cell therapy amongst others).
To guide us through this complex subject we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has a major clinical expertise in the management of multiple sclerosis amongst many other acute and chronic neurological conditions, please join me in this conversation with Ernie.

References:

Assoc professor Ernie Butler: Frankston neurology.com.au

www.ms.org.au

www.ninds.nih.gov , Multiple sclerosis : Hope Through Research

www.sciencedirect.com , Multiple Sclerosis-an overview

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…

Neoplastic transformation results in the development of neuroendocrine tumours (NET’S) most commonly in the small bowel (~60%) followed by the lungs (~27%) and pancreas.

Whilst considered rare more than 5000 diagnoses per year occur in Australia which is more than the combined number of annually reported pancreatic and gastric malignancies. Unfortunately, up to 60% of cases are advanced at the time of diagnosis with metastases and is not uncommon for patients to be misdiagnosed with irritable bowel syndrome. Neuroendocrine tumours may be functional or non-functional (the majority), they may be poorly or well-differentiated, low-grade or high-grade.

NET's have somatostatin receptors (there are 5 known receptors) on the cell surface and up to 80% of NET's express somatostatin receptor 2 which octreotide has a strong attraction for. The gallium dotatate scan exploits this fact by detecting the presence of the somatostatin 2 receptor.

Neuroendocrine cells also contain vesicles stacked with chromogranin which has been utilised as a relatively sensitive and specific marker for NET although elevated levels of this marker may be seen with proton pump inhibitors, renal impairment and atrophic gastritis. 24-hour measurement of urinary 5 hydroxy indole 3 acetic acids (5-HIAA), the degradation product of serotonin, is a useful laboratory marker for NETs producing serotonin.

I was particularly interested to explore this extensive subject further with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers from the Peter MacCallum Cancer Centre all experts in managing neuroendocrine tumours and I was keen to discuss peptide receptor radionucleotide therapy (PRRT) which Professor Hicks whose expertise with this therapy is world renown. Please welcome them to this two-part podcast.

REFERENCES:

petermac.org

neuroendocrine.org.au

www.ncbi.nih.gov (Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours,2020)

www.sciencedirect.com

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…

Neoplastic transformation results in the development of neuroendocrine tumours (NET’S) most commonly in the small bowel (~60%) followed by the lungs (~27%) and pancreas.

Whilst considered rare more than 5000 diagnoses per year occur in Australia which is more than the combined number of annually reported pancreatic and gastric malignancies. Unfortunately, up to 60% of cases are advanced at the time of diagnosis with metastases and is not uncommon for patients to be misdiagnosed with irritable bowel syndrome.
Neuroendocrine tumours may be functional or non-functional (the majority), they may be poorly or well-differentiated, low-grade or high-grade.

NET's have somatostatin receptors (there are 5 known receptors) on the cell surface and up to 80% of NET's express somatostatin receptor 2 which octreotide has a strong attraction for. The gallium dotatate scan exploits this fact by detecting the presence of the somatostatin 2 receptor.

Neuroendocrine cells also contain vesicles stacked with chromogranin which has been utilised as a relatively sensitive and specific marker for NET although elevated levels of this marker may be seen with proton pump inhibitors, renal impairment and atrophic gastritis. 24-hour measurement of urinary 5 hydroxy indole 3 acetic acids (5-HIAA), the degradation product of serotonin, is a useful laboratory marker for NETs producing serotonin.

I was particularly interested to explore this extensive subject further with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers from the Peter MacCallum Cancer Centre all experts in managing neuroendocrine tumours and I was keen to discuss peptide receptor radionucleotide therapy (PRRT) which Professor Hicks whose expertise with this therapy is world renown.
Please welcome them to this two-part podcast.

REFERENCES:

petermac.org

neuroendocrine.org.au

www.ncbi.nih.gov (Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours,2020)

www.sciencedirect.com

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Pancreatic cancer is the eighth most common cancer reported in Australia. In 2021, it is estimated that there will be 4261 new cases and 3391 deaths. The incidence has increased from 10 per 100,000 in 1982 -to 12 per 100,000 today with the average age of onset between 60 and 65 years. At the time of diagnosis, approximately one-third of patients already have advanced disease with a limited 3 to 4-month survival prognosis, overall, 1-year survival for pancreatic cancer is only 16% and 5-year survival of 3% despite new approaches to management.

Risk factors include obesity, smoking (fivefold increase risk) and type 2 diabetes mellitus which after cigarette smoking and obesity is likely the third most modifiable risk factor for pancreatic cancer.

Other risks include family history (7%) and autosomal dominant syndromes such as Hereditary pancreatitis, Peutz-Jeghers syndrome, Hereditary breast and ovarian cancer syndrome (BRCA 2 and 1 genes), and Lynch syndrome and the Familial atypical multiple mole melanoma syndromes.

Additionally, there is probably a risk associated with ongoing heavy alcohol consumption and subsequent chronic pancreatic inflammation.

After imaging and subsequent diagnosis, staging determines locally respectable, borderline respectable, locally advanced unresectable or metastatic disease, and guides the choice of surgery, chemotherapy, radiotherapy and or palliation.

It was a privilege to be joined in this conversation by Dr Michael Lee from the Peter McCallum Cancer Centre, an oncologist specialising in clinical translational genomic research and advanced cancers with a special focus on metastatic pancreatic cancer. Michael trained in Australia and subsequently worked in Vancouver at the BC Cancer and Michael Smith's Science Centre before returning to Melbourne where he is undertaking a PhD with the aim of developing a new novel therapy for pancreatic cancer. Michael’s motto is to provide holistic oncology care with an honest conversation, supported by the latest research from the bench side to the bedside and tailoring it to his patient’s goals and wishes.

References:

www.petermac.org

canceraustralia.gov.au

www.cancer.org.au

www1.racgp.org.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

As case numbers and deaths continue to climb from Covid 19 infection and its many variants, two antiviral drugs have entered the market and are now available on the Australian PBS with specific prescription criteria to be met. So, what are they and what do they do?

Molnupiravir - Made by Merck in collaboration with Ridgeback Biotherapeutics was the 1st to be introduced to Australia as a trade named Lagevrio available from March 1st. This drug is a polymerase inhibitor administered as four tablets twice daily for a five-day course and works by stopping Covid 19’s genetic material from being replicated accurately. By inhibiting the virus’s own polymerase, it induces replication errors so that ultimately the virus is unable to survive with these. This is the so-called catastrophe method. A question for our guest relates to this drug’s safety…. for example: Could this drug also affect host enzymes?

Paxlovid - takes a different approach the drug consists of Nirmatrevir, and an existing drug called Ritonavir. These are protease inhibitors affecting the viral proteases which cut apart long strands of non-functional viral protein into smaller functional proteins. Nirmatrevir is the drug working on this whilst Ritonavir prevents other enzymes from destroying Nirmatrevir. Ritonavir may be found elsewhere and used in anti-HIV cocktails. Paxlovid is also taken BD for five days.

These drugs are most effective when given early and the PBS criteria states these drugs are for adults who have mild to moderate COVID-19 confirmed by a PCR or medically verified RAT and who can start treatment within 5 days of symptom onset if:

o they are 65 years of age or older, with two other risk factors for severe disease (as increasing age is a risk factor, patients who are 75 years of age or older only need to have one other risk factor); or

o they identify as Aboriginal or Torres Strait Islander origin and are 50 years of age or older with two other risk factors for severe disease, or

o they are moderate to severely immunocompromised.

We should draw attention to:

Evushield (Tixagevimab+ Cilgavimab) and Sotrovimab

We need a primer on who should receive these and will discuss this with our guest shortly.

And what about other drugs that have at times perhaps controversially been recommended around the globe such as?:

Chloroquine and Ivermectin

And then is there an early place for steroid prescription?

To expand our knowledge on this emerging and complex subject please welcome to the podcast Dr Alex Tai Infectious Diseases specialist with a special interest in public health, tropical medicine, multi drug microbial resistance and travel medicine.

For more information on this episode please visit: https://www.gihealth.com.au/everyday-medicine-podcast-blog/special-episode-11-anti-virals-for-covid-19-with-dr-alex-tai

References:

Dr Alex Tai-Infectious Diseases Physician-

www.bawbawphysicians.com.au

www.health.gov.au

What GPs need to know about the new Covid antivirals: www1.racgp.org.au

Antiviral treatments for Covid 19-NPS MedicineWise-www.nps.org.au

Liverpool COVID -19 Interactions : www.covid19-druginteractions.org

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.

There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.

Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Non-Hodgkin's lymphoma can occur at any age and although the median age at diagnosis is 67 years it is one of the more common cancers among children, teens and young adults, none the less the risk of developing NHL increases throughout life and more than half the patients with NHL are 65 years or older at diagnosis. It is also more common amongst men and those with autoimmune diseases or a family history of hematologic malignancies. Presentations often involve the finding of involved lymph nodes on either side of the diaphragm. 85% of non-Hodgkin lymphomas are B cells in origin, and 15% are T cells. The most common the B cell non-Hodgkin lymphomas are diffuse large B cells -accounting for 37% of NHL cases, followed by follicular 29%, Malt 9% and Mantle cells 7%.
This is a complex and vast subject with a number of environmental factors and associated diseases influencing the fascinating pathogenesis of lymphoma which goes to the heart of B cell biology and our immune systems’ task of fighting for our lives against antigen invaders. There are a host of treatment options available with new emerging therapies at the cutting edge of medicine and it was a privilege to have a conversation with Professor Stephen OPAT -and to journey for a short time into his world of haematology. Stephen is the professor and director of clinical haematology at MMC and has a special interest in lymphoma, chronic leukaemia, cancer genomics and disorders of metabolism. I found Stevens’ conversation incredibly insightful and welcome you to this podcast:

References:

www.melbournehaematology.com.au

www.ncbi.nlm.nih.gov

www.cancer.org

www.uptodate.com

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.

There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.

Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Non-Hodgkin's lymphoma can occur at any age and although the median age at diagnosis is 67 years it is one of the more common cancers among children, teens and young adults, none the less the risk of developing NHL increases throughout life and more than half the patients with NHL are 65 years or older at diagnosis. It is also more common amongst men and those with autoimmune diseases or a family history of hematologic malignancies. Presentations often involve the finding of involved lymph nodes on either side of the diaphragm. 85% of non-Hodgkin lymphomas are B cells in origin, and 15% are T cells. The most common the B cell non-Hodgkin lymphomas are diffuse large B cells -accounting for 37% of NHL cases, followed by follicular 29%, Malt 9% and Mantle cells 7%.
This is a complex and vast subject with a number of environmental factors and associated diseases influencing the fascinating pathogenesis of lymphoma which goes to the heart of B cell biology and our immune systems’ task of fighting for our lives against antigen invaders. There are a host of treatment options available with new emerging therapies at the cutting edge of medicine and it was a privilege to have a conversation with Professor Stephen OPAT -and to journey for a short time into his world of haematology. Stephen is the professor and director of clinical haematology at MMC and has a special interest in lymphoma, chronic leukaemia, cancer genomics and disorders of metabolism. I found Stevens’ conversation incredibly insightful and welcome you to this podcast:

References:

www.melbournehaematology.com.au

www.ncbi.nlm.nih.gov

www.cancer.org

www.uptodate.com

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

In May this year, new cases of the rare infection - Monkey Pox - typically limited to Africa, began spreading within Europe and North America.

More than 780 cases have now been reported across 15 countries with Australia recently reporting 8 cases.

www1.racgp.org.au - Monkeypox exposure, a member of the same family of viruses as smallpox and typically is spread through close physical contact with skin lesions, body fluids, respiratory droplets, and conta minated materials such as bedding and is much less infectious than respiratory illnesses such as Covid 19. Transmission of Monkey pox virus by respiratory droplets would normally require prolonged face-to-face contact, so the apparent rapid spread of the virus may signal a shift in its behaviour and some scientists have questioned if the virus may have mutated to become more transmissible. Two strains have been identified.

The west African strain has a 1-3% mortality and is the strain currently spreading beyond Africa. The Central African strain is more deadly with a 10% mortality rate.

Infection is characterised by: Lymphadenopathy, muscle aches, fever, headache, and a pustular rash developing 1-3 days after the fever and typically starting on the face before spreading to other parts of the body.

It’s estimated that just 3% of close contacts of Monkeypox will become infected however asymptomatic spread is being postulated and another unusual feature of the current outbreak is the detection of cases through sexual health services and amongst same-sex men.

As smallpox was declared eradicated in 1980 the last mass vaccination against smallpox was in the 1970’s and it is speculated that declining herd levels of immunity against smallpox may be leading to the current propensity for transmission.

I thought it may also be interesting to expand the conversation with our guest beyond Monkeypox to discuss the recent spike in cases of Japanese encephalitis reported in Australia, noting that JEV is a mosquito-born presenting with fever, vomiting and headache and linked to piggeries as well as pig handling and abattoirs.

Please welcome Dr Alex Tai Infectious Diseases specialist with a special interest in public health, tropical medicine, multi-drug microbial resistance and travel medicine.

References:

Dr Alex Tai-Infectious Diseases Physician-www.bawbawphysicians.com.au

www1.racgp.org.au -Monkeypox exposure

Monkeypox-Fact sheets-NSW Health-www.health.nsw.gov.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Dr John Levin practices antiaging medicine and joins this podcast to discuss his practical approach to treatment. As John laments antiaging medicine is not taught in medical school yet he believes the science of anti-ageing holds the key to significantly reducing human suffering and improving health span. Whilst the average human life span continues to increase and modern medicine more efficiently tackles diseases, the science of anti-ageing looks at mechanisms leading to cell degeneration and decay and seeks ways to regenerate cell health and thereby delay the many diseases associated with ageing.

Many believe that regeneration clinics where therapies include removing senescent cells repairing damaged DNA and perhaps topping up a reservoir of stem cells will become a reality sooner than one might think. Until such time, however, the simple caveats of avoiding smoking and excess alcohol, adopting a healthy body mass index, controlling blood pressure and blood sugar levels, exercising, and paying attention to good nutrition, sleep and dental hygiene as well as receiving vaccination should be considered as best proven advice. John's approach dives deeper into the science and includes measurement of serum growth hormone with a physiological replacement only if required and he also uses a number of supplements included in the list below:

ANTI-AGING SUPPLEMENTS  New York Academy of Science journal: work done by Cardiac Surgical Research Unit, Alfred Hospital, the Baker Heart Research Institute Melbourne and Department of Biochemistry and Molecular Biology Monash University showed that Co-Enzyme 010, Alpha Lipoic Acid and Magnesium Orotate helped protect the aging heart against stress. In addition, work performed by the Karolinska Institute in Sweden showed that adding Selenium to Co-Q10 improved heart function and slashed mortality risks by almost 5O%.  POO (Pyrroloquinoline Quinone) not only protects mitochondria from oxidative stress -it promotes the spontaneous generation of new mitochondria within aging cells, a process known as 'mitochondrial biogenesis'.

Carnosine can provide benefits to cells and tissues throughout the body that would otherwise succumb to the pathological effects of aging. Over 2000 studies have shown the beneficial effects in preventing age-related diseases such as type 2 diabetes, cardiovascular disease, dementia and cancer.   Pterostilbene has multiple benefits in the treatment and prevention of human disease due to its antioxidant, anti-inflammatory and anticarcinogenic properties.  Dr Bruce Ames, a world-renowned biochemist at the University of California showed that Acetyl L-Carnitine and Alpha Lipoic Acid could provide protection against the pathological hallmarks of aging.   L-Citrulline increases your L-arginine which is converted into nitric oxide which causes blood vessels to dilate and helps lower blood pressure. It helps the brain function by promoting greater circulation to the brain. It also helps the body get rid of ammonia in the form of urea.

Fisetin research by the Mayo Clinic shows it helps get rid of senescent cells (Cells that no longer divide). These cells accumulate with age and at sites of multiple chronic conditions such as diabetes, lungs in chronic pulmonary diseases, vascular diseases and joints in osteoarthritis.   NMN (Nicotinamide Mononucleotide) Professor David Sinclair, professor of Genetics at Harvard University says that this molecule is the missing key to regenerating healthy cells through 'old' age allowing your youthful existence to be sustained for much longer.  Metformin New research is suggesting that metformin may hold promise in treating or preventing a whole host of conditions. It may be cardioprotective, it may prevent cancer, be neuroprotective and reduce dementia and stroke risk.   D-Ribose Is involved in the energy production in all cells of the body.

Good oral health is fundamental to overall health and well-being, and a person's quality of life is compromised without it. By Oral health, we are referring to the condition of a person's teeth and gums, as well as the health of the muscles and bones in their mouth. Tooth decay, gum disease and tooth loss affect many Australian children and adults and contribute 4.5% of all the burden that non-fatal diseases place on the community. Most oral health conditions are largely preventable, and it is estimated by the World Health Organization that oral diseases affect close to 3.5 billion people worldwide, with three out of four people affected living in middle-income countries. Many factors contribute to poor oral health, including consumption of sugar, tobacco and alcohol as well as a lack of good oral hygiene and regular dental checkups. Additionally, a lack of fluoridation in some water supplies and a lack of access and availability to dental care impact adversely. There are also recognised links between poor oral health and chronic diseases, including cardiovascular disease, cerebrovascular disease, diabetes, oral cancers, pulmonary conditions and adverse pregnancy outcomes. Socially disadvantaged and indigenous Australians are more likely than others to experience untreated dental and oral disease, which negatively impacts their health outcomes.

This important subject is certainly worthy of further discussion, and it was a pleasure to meet Dr Asef Anwar, a registered Dental Surgeon with a passion for oral medicine. He is a graduate of the University of Sydney Dental School and has degrees as a Bachelor of Medical Science as well as being a Doctor of Dental Medicine. He has worked across private practices in both New South Wales and Victoria and has special interests in complex Full Mouth Rehabilitation, Dental Implants, Oral Surgery and Cosmetic Dentistry. He is committed to continuing education and research and is extending his knowledge and studies as the Oral Medicine Registrar at the University of Melbourne. It was a real pleasure to conduct a conversation with him today on the subject of Oral Medicine, exploring its interface with the practice of general medicine. I was curious to learn more about the relationship between oral mucosal and dermatological conditions, oral manifestations of systemic conditions, orofacial pain management and oral cancers. Another area of interest I was keen to explore related to the treatment of obstructive sleep apnea with mandibular advancement and dental splints, as well as broaching the subject of dental implants. With these points in mind, please welcome Dr Asef Anwar to the podcast.

References :

Dr Asef Anwar, MBedSci, DMD, FRACDS, FICOI. https://www.drasef.com.au

Australian Institute of Health and Welfare. aihw.gov.au

Australian Dental Association. https://ada.org.au

PCOS is the most common endocrinopathy of reproductive age women affecting about 1 in 10. Characteristically the condition presents with menstrual irregularity, excess androgens, and polycystic ovarian morphology. More common in women with a family history and type 2 diabetes the condition is associated with obesity, infertility, pregnancy complications and metabolic derangements as well as a number of psychological consequences.

In this podcast we have a conversation with obstetrician and gynaecologist Dr Mei Cheah founder of Create Health a leading group of specialists in women's health creating visions for a healthy future, better well-being, and more informed patients. Create Health aims to deliver exceptional care across obstetrics, gynaecology, reproductive endocrinology, minimally invasive surgery, fertility and IVF plus allied and complimentary health services. We look forward to exploring the practical aspects of this diagnosis further with you.

References:
Dr Mei Cheah is at create-health.com.au and https://createfertility.com.au/our-team/dr-mei-cheah/

www.jeanhailes.org.au

www.ncbi.nlm.nih.gov

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Endometriosis is the presence of endometrial tissue outside the uterus or embedded within its muscular wall. This unusual condition is known to induce a chronic inflammatory reaction that may be associated with pelvic pain and infertility. In women of reproductive age the estimated prevalence is 7 to 10% and up to one third of women undergoing laparoscopy for pelvic pain are diagnosed with endometriosis. Endometrial deposits may be deeply infiltrating, found in the abdomen and pelvic region may be invading the ovary but also found in the lungs, pleura and on the diaphragm. Ectopic endometrial tissue within the uterine myometrium is referred to as adenomyosis and may be responsible for heavy menstrual bleeding, some estimates place adenomyosis with a prevalence of 20 to 28%.

Pathogenetic mechanisms including retrograde menstruation and coelomic metaplasia as well as the induction theory have been proposed. In this podcast we have a conversation with obstetrician and gynaecologist Dr Mei Cheah founder of Create Health a leading group of specialists in women's health creating visions for a healthy future, better well being and more informed patient's. Create Health aims to deliver exceptional care across obstetrics, gynaecology, reproductive endocrinology, minimally invasive surgery, fertility and IVF plus allied and complimentary health services. We look forward to exploring the practical aspects of this diagnosis further with you.

References:
Dr Mei Cheah is at create-health.com.au and https://createfertility.com.au/our-team/dr-mei-cheah/ 

www.endometriosisaustralia.org

www.ncbi.nlm.nig.gov

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

In this episode we explore investigations in rheumatology-what is helpful and what is not?
A clinician faced with a patient complaining of myalgias and generalised rheumatic aches may be tempted to order a host of immunological and inflammatory tests whilst also assessing multiple other differential diagnoses that need considering. There are a host of serological tests available each with different degrees of sensitivity and specificity for rheumatological conditions, furthermore it is important to understand the sensitivity (ability to rule out condition) and specificity (ability to rule condition in) is applied to such tests. Fortunately, we had the opportunity to have a conversation with Dr Andrew Teichtahl who provides excellent clarification on the subject.

Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.

References:

Dr Andrew Teichtahl: www.arthritiscentre.com.au

www.racp.edu.au Investigations: In Medicine-Rheumatology-RACP

www.ncbi.nlm.nih.gov : Common Laboratory Tests for Rheumatological Disorders, ED Gupta 2009

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

The past two decades have witnessed dramatic changes in the approach to managing rheumatologic conditions, born of a wider understanding of cellular biology, immunology, and the pathophysiology of inflammation we have consequently seen an explosion in the development and availability of both Biologic medications and small molecules for medical applications.
Some of these products are designed to interfere with cytokine function or production and include:

· TNF inhibitors

· TNF receptor fusion proteins

· IL6 inhibitors

· IL-17 inhibitors

· IL-12/23 inhibitors

· T-cell modulators

· B cell modulators

In addition, the development of small molecules as Janus kinase inhibitors has opened up new channels for inflammatory modulation.

It was a great privilege to welcome rheumatologist Dr Andrew Teichtahl to this podcast to help us understand how to apply this new age of science to the practice of rheumatology. Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.

References:

Dr Andrew Teichtahl: www.arthritiscentre.com.au

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911251/ New era of treatment with biologics in rheumatology – is it time to shift paradigms in treatment with biologics? Anna Felis-Giemza

www.nature.com/articles/nrrheum.2009.197,  Are new agents needed to treat RA ?

https://arthritis-research.biomedcentral.com/articles/10.1186/1478-6354-13-S1-S5 Advances in rheumatology: new targeted therapeutics

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Trillions of microbes are living in and on us, a thriving ecosystem of bacteria, viruses, archaea and fungi. Collectively these microbes form the human microbiome and this microbiome appears to play a key role in many aspects of health, crowding out harmful microbial invaders, breaking down fibrous food into digestible compounds and producing some essential vitamins such as B12 and vitamin K. New research is exploring the relationship between the gut microbiome and immunogenicity, autoimmune inflammatory diseases, neoplasia and brain development and is searching ways to correct dysbiosis.

In this episode with Professor Mark Morrison, Chair of Microbiology and Metagenomics at the University of Queensland Diamantina Institute we explore the human microbiome and how his work is expanding our understanding of this interesting clinical area of research and its possible medical applications.

Useful references include:

- Professor Mark Morrison - The University of Queensland Diamantina Institute

- WGO Handbook on Gut Microbiome – A global perspective - www.worldgastroenterology.org

- Gut microbiome – An Overview – www.sciencedirect.com

- Human Gut Microbiome : Hopes Threats and Promises – https://gut.bmj.com

- The Gut Microbiome in Health and in Disease – www.ncbi.nlm.nih.gov

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Breast cancer affects 1 in 7 women and remains the most diagnosed cancer in Australia with 57 new cases diagnosed each day, 1000 new cases per year and tragically 2000 deaths annually. Men are not excluded, for every 100 breast cancers one is diagnosed in a male. Genetic links for breast cancer such as the BRCA 1 and 2 genes receive significant attention but account for only 5% of total cases,75% of patients have no family history and additionally 75% of breast cancers are diagnosed in patients 50 years or older. Multiple risk factors including family history, young age of menarche and older age of menopause are frequently cited but less well known is the association with obesity which is responsible for up to 8% of all breast cancers. It is estimated that 1: in 4 cases of all breast cancer may be prevented with attention to known modifiable risk factors. Breastfeeding and earlier age of pregnancy are both protective factors.

In this episode we are joined by breast cancer surgeon Corinne Ooi who reviews risk factors linked to breast cancer and discusses management strategies when a breast lump is detected. This is a fascinating conversation with a truly passionate surgeon.

Useful references include:

- Dr Corinne Ooi – Southern Breast Oncology - sboncology.com.au

- Breastcancerriskfactors.gov.au - www.canceraustralia.gov.au

www.aihw.gov.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Dr Natharnia Young is a leading urogynaecologist servicing South Eastern Melbourne’s suburbs and joins this conversation to discuss urinary incontinence in women, a condition associated with significant personal and social stigmatisation and affecting up to 1:2 women over the age of 70.

Rates of presentation by woman seeking management for stress incontinence and urge incontinence are low, perhaps on account of feelings of embarrassment and shame however there are many effective management strategies that Natharnia discusses in this very informative podcast episode.  Please enjoy the conversation.

Useful references include:

• Dr Natharnia Young – Australian Pelvic Floor Institute.  enquiries@afpsinstitute.com
• Urinary Incontinence – symptoms and causes – Mayo Clinic – www.mayoclinic.org
• Urinary Incontinence – Office on women’s health – www.womenshealth.gov
• Urinary Incontinence in Women – www.ncbi.nlm.nih.gov

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

#urinaryincontinence #urogynaecologist #EverydayMedicine 

Dr Peter Brukner OAM is Professor of Sports Medicine at the Latrobe Sport and Exercise Medicine Research Centre and is one of Australia’s most respected and best-known specialist sports physicians with a wide breadth of knowledge of the subject. He has extensive experience, having enjoyed a stellar career with elite sports teams and Olympians over multiple decades in his professional capacity.

In this episode we discuss, several questions related to commonly used supplements taken by amateur and high-level athletes as well as delving into the darker realm of banned substances including anabolic steroids such as DHEA, testosterone and growth hormone. This is a tremendous conversation with master raconteur and communicator. Please enjoy the episode.

Useful references include:

- www.lowcarbdownunder.com.au

- peterbrukner.com

- youtube Professor Tim Noakes – “Medical aspects of the low carbohydrate lifestyle”

- ods.od.nih.gov – National Institutes of Health, Dietary Supplements for Exercise and Athletic Performance (the fact sheet for health professionals)

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Dr Peter Brukner OAM is Professor of Sports Medicine at the Latrobe Sport and Exercise Medicine Research Centre at Latrobe University and is one of Australia’s most respected and best known specialist sports physicians. He has a deep breadth of knowledge and experience and was a founding partner at the Olympic Sports Medicine Centre in Melbourne as well as a sports physician to the Collingwood and Melbourne AFL clubs, Liverpool Football Club and has served as team doctor to the Australian cricket team, Socceroos and several Olympic teams. He has authored multiple best-selling books on sports medicine and more recently has become interested in the important relationship between lifestyle and health and after determining that he was pre-diabetic he embarked on a low carbohydrate ketogenic style diet. He has subsequently become a strong advocate of the low carbohydrate diet both in managing a healthy BMI and avoiding development of the metabolic syndrome and all its consequent health effects and authored the very popular and best-selling book A Fat Lot of Good. He energetically has also established the not for profit campaign Sugar By Half. He joins us today to discuss his experience and journey to a low carbohydrate diet and how such an approach may be highly beneficial to athletes of both amateur and elite persuasions. Please enjoy this podcast.

Useful references include:

- www.lowcarbdownunder.com.au

- peterbrukner.com

- youtube Professor Tim Noakes – “Medical aspects of the low carbohydrate lifestyle”

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

The Peter Doherty Institute was the first Australian laboratory to establish a Covid 19 PCR test and diagnose the first SARS-Cov 2 infection on Australian shores, its research scientist is heavily involved in developing novel diagnostic tools applied across many areas of medical science and the institute plays a key leadership role in advising state and federal government on best medical practice. It’s no great surprise therefore that we have learned of their ground-breaking development of a new subunit Covid 19 vaccine utilising the receptor binding domain at the tip of the virus’s spike proteins. This is the region responsible for virus attachment and infection and for eliciting over 90% of neutralising antibodies following SARS Cov-2 infection. Parallel with the subunit vaccine development, another Melbourne group – the Monash Institute of Pharmaceutical Sciences has developed a similar vaccine but using mRNA technology copying the virus’s genetic sequence that codes for the receptor binding domain.

These vaccines enter the pantheon of other existing mRNA/viral vector/and subunit protein vaccines already available offering protection against Covid 19 but are different as they focus the immune response to the tip of the spike protein – the important receptor binding domain.

Both new Melbourne developed vaccines are entering phase 1 trials and results will be eagerly awaited.

Professor Dale Godfrey is a senior principal research fellow and immunology theme leader at the Doherty Institute and has played a major role in RBD subunit protein vaccine development.

Please join this conversation where Dale discusses the new vaccine development, their efficacy, and the phase 1 clinical trials evaluating the vaccines further.

References:

Professor Dale Godfrey: godfrey@unimelb.edu.au

doherty.edu.au

Phone: 83449325 for further trial information or at virgo-studies@unimelb.edu.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Cardiovascular disease is a major cause of mortality in Australia, responsible for around one in four (24%) of all deaths. On average, around 120 people in Australia die from CVD each day - equivalent to one person every 12 minutes. 40% more men die from CVD compared to women. With these statistics in mind, it is perhaps as well that the field of cardiology appears to be galloping toward the future with exciting treatments to manage this substantial burden of disease. We are witnesses to the development of incredible percutaneous interventions, including coronary stenting, valve replacements and repairs, watchman devices, radio frequency ablations as well as enhanced diagnostic tools and pharmacologic choices. At times, I have found the pace of change difficult to stay current with and was interested in putting some questions forth to my colleague, Dr James Sapontis to clarify my understanding and build my knowledge base. I was curious about the protocols around dual platelet therapy and their combination with DOACS, a combination I have observed leading to increased occult and overt gastrointestinal bleeding and the escalating use of iron infusions to correct deficiency states and Capsule studies to determine oozing sites. I was also interested in the indication for the use of mitraclips, the place of B-type Natriuretic peptide test in the elucidation of heart failure, as well as many more developments that have solidified their place in the clinical world of cardiology.

Please join me with the ever-patient and erudite cardiologist James Sapontis as we explore these points in more detail.  

References:

Dr James's Sapontis : www.jamessapontis.com

Cardiac Society of Australia and New Zealand. Guidelines for the management of antiplatelet therapy in patients with coronary stents undergoing non-cardiac surgery. 

⁠Royal Australian College of General Practitioners (RACGP)⁠

⁠https://www.racgp.org.au › afp ⁠ ⁠CSANZ⁠

⁠https://www.csanz.edu.au⁠

Delivering hard news to a patient or their relatives and admitting error can be one of the most difficult duties encountered by a doctor. Significant effort is now spent in teaching young training doctors techniques and strategies to avoid miscommunication and uncertainty in undertaking this complicated task whilst also remaining emotionally engaged and empathetic to their situation.

Rabow and McPhee have written eloquently on the subject of breaking difficult or bad news and have devised a mnemonic using the letters ABCDE as an excellent guide to this subject.

Accepting responsibility and apologising genuinely to a patient and their relatives for an error incurred during care requires courage and honesty and both Rabow and McPhee as well as the Harvard School of Public Health have written informatively on this subject.

In this episode we are joined by Dr Alan Saunder, Program Director of Surgery at Monash Health and both vascular and transplant surgeon with Dr Bill Shearer Consultant Anaesthetist and Executive Director of Quality Safety and Transformation at the Northern Hospital. We discuss these very important subjects with the honesty and wisdom of many years of advanced clinical practice.  I believe you will find this conversation both helpful and engaging.

Useful references include:

-  www.ncbi.nlm.nih.gov - Beyond Breaking Bad News: How to help patient who suffer

-  www.aafp.org - Breaking Bad News – American Family Physician, G. VandeKieft.2001

-  Harvard School of Public Health – www.hsph.harvard.edu

-  Mistakes Were Made (But Not by Me) by Carol Tavris and Elliot Aronson, (Chapter 8)

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Chronic pain affects about 1 in 5 people in Australia and is a common reason for patients to see their doctor and to seek treatment. As patients seek ever increasingly strong pharmacological therapies they may become increasingly depressed, fatigued and dislocated from society.

In this episode we have a very interesting conversation with Dr Stephen Nutter, we follow Stephen’s journey from anaesthetist to pain management consultant at Metro Pain Clinic and discuss his approach to:

· Non-pharmacological

· Pharmacological

· Interventional approaches to chronic pain management

Stephen provides us with his personal approach to some common clinical pain syndromes, which we explore as a great introduction to this topic. I am delighted to share the conversation with you.

Useful references include:

www.painaustralia.org.au

www.apsoc.org.au

www.racgp.org.au

www.metropain.com.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Genetic testing for cancer is important for a small number of families at increased risk due to the inheritance of genetic mutations. Most commonly this involves the inheritance of breast cancer genes such as the BRCA 1 and 2 or colorectal cancer genes such as the Lynch syndrome genes. Although these only represent a small percentage of total cancers reported there is significant public interest in these syndromes.

We have a further discussion with Dr Lucy Gately from the Cabrini Family Cancer Clinic in this episode in regard to the BRCA 1 and 2 genes on chromosome 17 inherited by 1:400 women and men, and the Lynch syndrome genes which are accounted for by five mutations inherited by about 1:280 people. The Lynch syndrome is believed to affect about 80,000 Australians of whom perhaps only 5% know they have inherited this mutation. Whilst the BRCA 1 and 2 genes are associated with both breast and ovarian cancer in women, BRCA 2 inheritance may also imply an increased incidence of prostate cancer and breast cancer in men. Lynch mutations have been associated with up to 12 different forms of cancer although colorectal cancer and endometrial cancer are most highly represented by these mutations.

It is a great pleasure to discuss this fascinating subject in more detail with Dr Lucy Gately whose expertise on this complex subject is generously shared.

Useful references include:

- www.cabrinicancerclinic - BRCA gene mutations

- Genetic Testing Fact Sheet – www.cancer.gov

- Genetics: Breast Cancer Risk Factors – breastcancer.org

- BRCA 1 and BRCA 2 associated hereditary breast and ovarian cancer – www.ncbi.nlm.nih.gov

- Lynch syndrome – www.cancer.net

- What is Lynch syndrome – Lynch syndrome Australia – lynchsyndrome.org.au

- Understanding genetic tests for Lynch syndrome – Centre for genetics – www.genetics.edu.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

In the context of family cancer screening, genetic testing looks for specific inherited changes or variants in a person’s genes which may predispose them to an increased risk of developing a neoplasm. Harmful variants in some genes are known to be associated with an increased risk of developing specific cancers such as mutations to the BRCA 1 and 2 genes associated with breast and ovarian cancer and the Lynch genes associated with colorectal and endometrial cancer.

Alterations in tumour suppressor genes (loss of function) and proto-oncogenes (gains of function) are fundamental to our understanding of the science associated with family cancer syndromes and can be tested in the setting of family cancer screening clinics. The subsequent very important genetic counselling for patients and relatives who may have inherited such mutations involves discussing the risk of inherited cancer, individual risk screening and cancer risk reduction strategies.

In this episode, we are joined by Dr Lucy Gately and Lynne McKay from the Cabrini Family Cancer Clinic who have been instrumental in delivering one of Australia’s premier family cancer screening services and genetic counselling services to our community. Please welcome them to this conversation.

Useful references include:

- Family Cancer Clinic for Risk Assessment Advice and Testing – www.cabrini.com.au

- Family Cancer Centres – www.cancer.vic.org.au

- Genetic Testing for Cancer Risk – www.cancer.net

- Family Cancer Syndromes – American Cancer Society – www.cancer.org

- Cancer Genes – pubmed.ncbi.nlm.nih.gov

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

The ketogenic diet has recently become popular as an effective dietary approach to weight loss. The diet restricts carbohydrates to just 5-10% of total calories and relies on caloric intake from fats (55-60%) and proteins (30-35%) forcing metabolism to shift from gluconeogenesis to ketogenesis with the production of acetoacetate, beta-hydroxybutyrate and acetone – ketone bodies – as the usable energy source. People adopting this diet report a significant reduction in hunger, increase in energy, clarity of thought and reduction in chronic inflammatory conditions. Some are concerned the diet is difficult to maintain long term and may be risky in patients that are diabetic and in those with chronic kidney disease.

In this podcast episode, we delve deep into the roots of the ketogenic diet and its benefits with Dr Rodney Taylor an expert educator and host of the increasingly popular and very well supported Low Carb Down Under science education program. Rod has been instrumental in bringing some of the world’s experts on metabolism and dietetics to conferences he hosts in Australia and his youtube channel Low Carb Down Under has over 325,000 subscribers. I was very privileged to catch up with Rod in this interview and welcome you to the conversation.

Useful references include:

- Dr Rod Tayler – lowcarbdownunder.com.au

- A Ketogenic Diet for Beginners: The #1 Keto Guide – www.dietdoctor.com

- Should you try the keto diet? Harvard Health – www.health.harvard.edu

- Ketogenic Diet – StatPearls – www.ncbi.nlm.nih.gov

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Before proceeding, we apologise for the audio quality in this week's episode. Unfortunately, we experienced some technical difficulties and we will endeavour to resolve these problems in future episodes of Everyday Medicine.

It is estimated that up to 80% of the population will experience back pain sometime in their lives with presentations from adolescent age to the elderly. Back pain is the third most common reason for visits to a medical practitioner and in many instances treatment strategies have already been sought elsewhere from chiropractors, physiotherapist myotherapists, personal trainers and osteopaths.
Radiological interrogation is often required to assist formulation of an appropriate treatment strategy and in this episode we discuss a radiological perspective of this problem with radiologist Dr Max Kupershmidt who has specialised in procedural radiology and musculoskeletal imaging.

Max completed radiology training at the Alfred Hospital in 2006 and worked there as an interventional radiology fellow before undertaking an Abdominal Imaging Fellowship in Toronto in 2008 . Max has been engaged in private radiology for the last 11 years and was a founding executive and treasurer of ARGANZ as well as running and organising many successful conferences and seminars. In this podcast we also discuss with Max the issue of radiation exposure in radiology noting that the average person may receive the equivalent of 3 mSv of radiation per year and that a plain chest x-ray delivers an equivalent of 7 days of background radiation and standard mammography about 7 weeks of equivalent background radiation. CT exposure with a modern scanner delivers approximately 2.6 years radiation, PET scans about 8 years equivalent exposure and MRI none. It is estimated that the additive lifetime risk from a CT scan from fatal and nonfatal malignancy is about 1 in 1100 (equivalent to the risk of drowning). As medical practitioners we all need to be aware of the exposure risk when ordering investigations particularly in our younger patients where the lifetime risk is very real. Please join this conversation with Max.

References:

Dr Max Kupershmidt: LinkedIn

www.cancer.org Understanding Radiation Risk from Imaging Tests

www.radiologyinfo.org Radiation Dose in Xray and CT Exams

www.racgp.org.au Radiation Safety

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Diabetic foot is the name given to the condition commonly experienced by people with diabetic peripheral neuropathy and results in an insensitive and often deformed foot. Found in both type I and type II diabetic patients (of which there are 1.8 million living in Australia-one new diagnosis is made every 5 minutes), even minor trauma in the diabetic foot may lead to the development of an ulcer. The combination of impaired vascular supply from micro and macro vascular disease and neuropathy presents real challenges for healing. Consequently, diabetic foot ulcer is a major event in 85% of subsequent amputations and is the cause of 20% of hospital admissions related to diabetes. Ten to 15% of diabetic foot ulcers fail to heal and of these, 25% lead to an amputation. In one study up to 50% of diabetic patients undergoing amputation were dead within 2 years. Failure to be seen and managed by medical attendants more than 6 weeks after developing an ulcer in a diabetic foot vastly increases the amputation risk however just one year after appropriate vascular surgical management, between 70 and 90% of limbs will be saved from amputation. Furthermore, one year after vascular intervention up to 60% of diabetic foot ulcers are healed, highlighting the importance of vascular surgical expertise early in the management of the diabetic foot.

In this episode we are joined by expert vascular surgeon Mr Ming Yii who is the director of vascular and transplant surgery at Monash Health and adjunct Senior lecturer with Monash University. Ming is part of the Monash transplant team in kidney and pancreas transplantation and brings a wealth of knowledge and experience as well as an effusive personality to accompany his skills. In this episode he discusses his approach to this major problem and the multidisciplinary strategy for management that is needed.

References:

mingyiivascular.com.au

www.webmd.com

www.bmj.com Diabetic foot. SC Mishra 2017

www1.racgp.org.au.diabetic foot ulcer

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

It is common in clinical practice to identify patients with impaired renal function as determined by diminished glomerular filtration rate and elevated creatinine. The decision to undertake thorough work-up and investigation of such patients or to observe and monitor, removing any potential offending nephrotoxic agent, is a clinical problem we address in this podcast with expert nephrologist Dr Tony Amin, who considers:

· Acute kidney injury

· Chronic kidney injury

· Appropriate management and work up

· Intravenous contrast nephrotoxicity

This is a complex subject with multiple considerations which Tony outlines with great clarity.

Useful references include:

- Dr Tony Amin – www.healthshare.com.au

- Okusa MD et al. Reading between the Guidelines – The KDIGO practice guideline on acute kidney injury in the individual patient. Kidney Int. 2014 January; 85(1):39-48

- Farrington K et al. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher: a summary document from the European Renal Best Transplant Group. Nephrology Dial Transplant. 2017 Jan 1:32(1):916

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Sodium is a major extracellular cation. Normal sodium concentrations range between 135 and 145 mmol/L. Alterations in sodium concentration, particularly hyponatraemia is the most common electrolyte disorder doctor’s encounter in clinical practice. Up to 20% of people admitted to hospital have hyponatraemia and it is estimated that 1.7% of population also have hyponatraemia.

It was enlightening to review this subject with Dr Tony Amin, nephrologist and public educator who discusses:

· The importance of assessment of serum and urine osmolality in conjunction with serum sodium and urinary sodium

· Assessment of patient’s volume status (hyper/hypovolemic)

· A variety of different clinical examples in respect to this subject

Please join me in this very engaging conversation with Tony whose expertise is evident from our discussions.

Useful references include:

- Dr Tony Amin – www.healthshare.com.au

- UpToDate

- HenryDa.In the clinic: Hypernatremia. Annals of Internal Medicine.2a15 August 4; 163(3);ITC1-19

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

The consequences of dementia with short term memory loss, visuospatial dysfunction, executive dysfunction, apathy, word-finding difficulty and apraxia is devastating both to the patient and family. It is estimated that 1% of Australians aged 65 years have dementia and that almost half of our population over 85 years have dementia to varying degrees. Alzheimer’s (60% of cases), vascular dementia (15% of cases), Lewy body and frontotemporal (each 5% of cases) and other forms of dementia secondary to alcohol, trauma and neurodegenerative disorders reflect the main forms of dementia seen in our society.

In this podcast we engage expert neurologist and cognitive specialist Dr Helene Roberts to discuss:

· Forms of dementia

· Appropriate investigation

· Management strategies

Helene guides us gently through this difficult and devastating clinical problem. Please join me in conversation with her.

Useful references include:

- www.dementia.org.au

- www.nia.nih.gov

- www.nhs.uk

- Dr Helene Roberts – www.healthshare.com.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

One in five people will develop heart failure in their lifetime. Half will have preserved ejection fraction- HFpEF, which is becoming increasingly prevalent, the other half have heart failure with reduced ejection fraction- so-called HFrEF. 

Separate to these two entities an extreme form of heart failure is cardiogenic shock. This most commonly occurs after acute myocardial infarction (AMI) and complicates AMI’s in 5-10% of cases. Cardiogenic shock is a clinical syndrome characterised by decreased cardiac output resulting in end-organ hypoperfusion and tissue ischemia. Patients presenting with ST-elevation myocardial infarction (STEMI) are 2-fold more likely to present with cardiogenic shock than those presenting with a non-STEMI.  Cardiogenic shock carries a poor prognosis and is the leading cause of death in patients with acute myocardial infarction. About 80% of patients with cardiogenic shock die despite optimal treatment, usually from complications including dysrhythmias, cardiac arrest, renal failure, ventricular aneurysm, stroke and thromboembolism. 

Treatment modalities include medical resuscitation and pharmacologic management, primary percutaneous coronary intervention, urgent coronary artery bypass grafting and artificial circulatory support, drawing upon intra-aortic balloon pumps and extracorporeal membrane oxygenation (ECMO). Additionally, there are non-intra-aortic balloon pump percutaneous mechanical devices as well as cardiac transplantation to consider. 

These treatments have reduced in hospital mortality yet, cardiogenic shock patients who survive to reach hospital discharge still have a higher rate of mortality post-discharge than uncomplicated AMI patients.

Some exciting new developments are afoot however with the recent introduction into clinical practice in Australia of the micro axial pump device. I was curious to learn more about this subject and new approach to management and was privileged to have this conversation on the subject with expert cardiologist Dr James Sapontis. James has been involved with some of the steering committees related to cardiogenic shock management and works actively as an interventionalist at many sites in Melbourne including St John of God Berwick and Victorian Heart Hospital. Please welcome James to the podcast. 

References:

Dr James's Sapontis : www.jamessapontis.com

https://www.ncbi.nlm.nih.gov › articles › PMC9930986 .Cardiogenic Shock Among Patients with Acute ST-Segment Elevation

Each year in Australia, over 125,000 of our more elderly population are admitted to hospital consequent to a fall. About a third of people over the age of 65 years fall each year and this figure rises exponentially with age. In up to 10% of falls, serious injuries such as fractures (a third of which are hip), soft tissue injuries and direct brain injuries arise. Falls and injuries from falls have serious implications and consequences.

In this podcast episode we are joined by geriatrician Dr Kim Tew who discusses:

· The complex relationship between balance, ambulation, cognitive function, neuromuscular function and cardiovascular function

· Appropriate management of an elderly patient following a fall

· The importance of early referral to a falls clinic or geriatrician with a view to careful work up, the deprescribing of medication, engagement of physiotherapy and occupational therapy.

Please join me in this interesting episode with Kim.

Useful references include:

- www.aihw.gov.au

- www.anzfallsprevention.org

- www.monash.edu – Fall-related injury profile for Victorians aged 65 – Monash University

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Couples are said to be infertile if pregnancy does not result after a year of carefully timed sexual activity without the use of contraceptives and is estimated to affect up to one in six Australian couples. It is also estimated that male partners contribute approximately 40% to cases of infertility, the same percentage as women. In a third of couples, a combination of male and female factors both need consideration. Today, women in Australia are 31 years of age before their first child is born compared to a generation ago where women on average were 24 years of age, this change in timing of first pregnancy and lifestyle may also be contributing to the difficulty some couples have starting their families.

In this conversation, we are joined by Dr Peter Yong, a specialist obstetrician and gynaecologist who works with Monash IVF and has a special interest in infertility and assisted conception. Peter trained in the United Kingdom and was awarded the gold medal in the membership examination at the Royal College of Obstetricians and Gynaecologists as well as being the recipient of the RCOG Young Obstetrician and Gynaecologist award. He also won a travel award to visit the Leuven Institute of Fertility and Embryology in Belgium. It was a privilege to have him on a conversation today to discuss:

· Incidence of infertility amongst couples

· Factors to consider

· Appropriate examination and workup

· Subsequent management strategies

Please join me in this very interesting conversation with Dr Yong.

Useful references include:

- www.sjog.org.au

- monashivf.com

- www.aafb.org

- www.ncbi.nlm.nih.gov

- www.nichd.nih.gov

- www.nhs.uk

- emedicine.medscape.com

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Altered uterine bleeding is estimated to affect 10-30% of women in midlife and constitutes about a third of outpatient gynaecological reviews. There are many aetiologies to consider including leiomyomas (fibroids), endometrial pathologies, polyps, malignancy, platelet dysfunction and coagulopathies.

In this conversation, we are joined by expert obstetrician and gynaecologist Dr Peter Yong who completed his undergraduate medical training in Singapore before undertaking postgraduate training in obstetrics and gynaecology in Scotland. He has a special interest in infertility and assisted conception and was awarded the gold medal in the membership examination at the Royal College of Obstetricians and Gynaecologists as well as being a recipient of the RCOG Young Obstetrician and Gynaecologist award. Peter also won a travel award to visit the Leuven Institute of Fertility and Embryology in Belgium. He works both in private practice and at Monash IVF and joins us in this discussion to consider:

· Causes of altered uterine bleeding

· Appropriate investigations and work-up

· Management strategies

Please join me in this very interesting conversation with Dr Yong.

Useful references include:

- www.sjog.org.au

- monashivf.com

- www.aafb.org

- www.ncbi.nlm.nih.gov

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

The detection of colorectal polyps is of critical importance in the prevention of colorectal cancer. Studies have demonstrated that colorectal cancer arises from colorectal polyps in more than 95% of cases. Fortunately most polyps do not become malignant (less than 1%) and it is known that less than 5% of all colonic adenomas harbour malignancy. The National Bowel Cancer Screening Program has been a government initiative to assist in the detection of early cancers and malignant polyps through the detection of occult haemoglobin in stool and some larger clinical trials have demonstrated the benefits of screening population this way. Once a malignant polyp is determined colonoscopically a fresh set of questions arises in regards to best management practice.

To discuss this topic of malignant polyps in more detail we are joined by expert colorectal surgeon Hanumant Chouhan, who covers:

· Detection of malignant polyps

· Surgical decisions to progress to resection vs relying on endoscopic removal

· Transanal total mesorectal excision (TaTME)

I am most grateful for his expert review of this subject. Please join me for this interesting conversation.

Useful references are:

- www.sjog.org.au

- www.ncbi.nlm.nih.gov

- www.surgery.wisc.edu

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Rectal bleeding is a very important clue to the possibility of serious internal colonic pathology. Whilst our approach to work up of patients with rectal bleeding is determined by the description of blood, the age of the patient and background history, it is extremely important not to overlook rectal bleeding as a possible early sign of a malignant polyp, premalignant polyp, colorectal malignancy or inflammatory bowel disease.

To discuss this subject in more depth we are joined by the very well-trained colorectal surgeon Hanumant Chouhan who discusses:

· Approach to rectal bleeding guided by patients’ age and family history

· Increased risk of colorectal malignancy in young patients

· Appropriate investigations and workup

Hanumant provides an excellent synopsis of this subject in conversation. Please join us on this episode.

Useful references are:

- www.sjog.org.au

- my.clevelandclinic.org

- www.mayoclinic.org

- www.asge.org

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Metabolic bone disease is common, it is estimated that about 4.75 million Australians have either osteopenia or osteoporosis. Osteoporosis affects up to 23% of women and 6% of men over the age of 50 with a markedly increased risk of minimal trauma fractures including hip fracture with increased morbidity and mortality. Osteoporosis is characterised by microscopic architectural deterioration of bone structure, loss of bone mass and a change in bone metabolism and can be confirmed by dual-energy x-ray absorptiometry (DEXA scan). Until recently 70-85% of patients presenting with a minimal trauma fracture have tended to be both under investigated for osteopenia and osteoporosis, nor appropriately managed to prevent a further fracture. Metabolic bone disease is a silent epidemic.

We are joined today by Dr Ie-Wen Sim who is an endocrinologist and andrologist with special interests including clinical andrology, reproductive endocrinology and metabolic bone disease. He is a graduate of the University of Melbourne with first class honours and the recipient of the NHMRC post graduate scholarship for osteoporosis research. In this conversation Ie-Wen covers:

· Incidence and aetiology of metabolic bone disease

· Comorbidities and risk factors including medications

· Diagnosis

· Medical interventions including use of anabolic and antiresorptive therapies

I hope you enjoy this fascinating conversation with Ie-Wen.

Useful references include:

- www.epworth.org.au

- www.osteoporosis.org.au

- www.aihw.gov.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Centrally mediated abdominal pain syndrome is a chronic recurrent condition that is not related to bowel function, diet or definite organic pathology such as inflammatory bowel disease, diverticulosis, vascular syndromes nor neoplasia.

It appears to be secondary to nerve sensitisation and may develop after significant emotional trauma or gastrointestinal infections.

The syndrome may be highly intrusive and distressing but can be managed by a multipronged approach drawing upon hypnosis, cognitive behavioural therapy and pharmacotherapy including antidepressants with deliberate avoidance of narcotics. 

In this episode, we have a conversation with an amazing pain physician-Dr Olivia Ong who has experienced her own personal trauma which she relates with us yet courageously has reentered the workforce at a high functioning level in the field of pain management. She continues to make major contributions to the community and her peers whilst raising a family, preparing for a TED talk and writing her first book. To discuss her journey from trauma back to life in medicine and also to introduce her new book soon to be released called: The Heart Centredness of Medicine, please join this interesting conversation with Dr Olivia Ong.

References:

https://drolivialeeong.com/book-pre-sale/

https://www.sciencedirect.com 

https://pubmed.ncbi.nlm.nih.gov 

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Covid vaccine induced Pericarditis-Myocarditis

Since the release of mRNA vaccines medical practitioners around the world have been receiving calls from patients complaining of chest discomfort typical of pericarditis some of these patients have also had associated ECG changes and cardiac enzyme elevation consistent with myocarditis. This phenomenon does not appear to be related to the non mRNA vaccines available. 

As of the 14th of November Australian data shows there have been 329 reports of likely myocarditis from 23.4 million delivered mRNA vaccine doses, a further 592 suspected but not confirmed cases and 1370 episodes of pericarditis. Based on this the TGA reported data for Australia estimates the rate of myocarditis or pericarditis after the first dose for men across all ages to be 2.1 per 100,000 and for women after the first dose to be 0.9 per 100,000. Rates following the second dose are higher with estimates of 2.7 per 100 000 for men and 1.1 per 100 000 for women. By comparison rates associated with the Covid 19 virus are estimated at the much higher rate of 11 per 100 000.

It should be noted that background normal rates of pericarditis for males aged 18-34 is 37 per 100,000 and for females aged 18-34 years the rate is 16 per 100,000.

TGA statistics also show higher suspected rates of myocarditis and pericarditis for boys aged 12-17 especially after their second dose of Pfizer estimated at 8.5 cases per 100,000 which is more than 3 times the overall rate amongst all males (2.7 per 100,000).

Reliable data for the Moderna mRNA vaccine are not yet available in Australia however overseas data suggests higher rates of myocarditis and pericarditis for male recipient's under the age of 30 years compared with the Pfizer vaccine.

It was a real privilege to have this conversation with Dr James's Sapontis director of cardiology at St John of God Hospital Berwick who has been fielding calls from primary practitioners seeing such patients and attending emergency admissions.

References:
Dr James's Sapontis : www.jamessapontis.com

www.health.gov.au :Covid 19 vaccination-Guidance on myocarditis and pericarditis

www.cdc.gov :Myocarditis and pericarditisafter mRNA Covid 19 vaccination

www1.racgp.org.au :TGA updates post-COVID vaccine myocarditis ratesTo be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Polyps are discreet mass lesions that protrude into the intestinal lumen and represent a very important precancerous pathology to be identified and removed at colonoscopy. Up to 95% of adenocarcinomas arise from polyps, such cancers develop either after inactivation of the APC gene (for adenomas) or by KRAS mutation or BRAF oncogene activation with methylation of promoter regions for the serrated polyp pathway. As colorectal cancer is one of the most commonly diagnosed cancers in Australia, with up to 1 in 18 males and 1 in 25 females developing cancer in their lifetime, identification and removal of polyps as demonstrated by the National Polyp Study remains an important objective at colonoscopy.

In this podcast we are joined by expert gastroenterologist Dr Geetha Gopalsamy to discuss:

· Adenomatous polyps

· Mucosal serrated polyps

· Mucosal non-neoplastic polyps

· Submucosal polyps

Focusing on the significance of each in relation to their clinical significance as well as providing pointers to the conversations we should have as clinicians with our patients about consent for colonoscopy and what to do with anticoagulation therapies pre-procedure. Geetha guides us systematically through this interesting subject.  I hope you can join us.

The useful references include:

- www.gihealth.com.au

- www.gesa.com.au

- www.gastrojournal.org

- The National Polyp Study Gastroenterology 1990

- pubmed.ncbi.nlm.nih.gov

- www.nham.org 23 February 2012

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Up to 23% or more of Australians have varicose veins which may include small spider telangiectasias to large cosmetically challenging varicosities. In this episode we talk with phlebologist Louis Loizou who runs a very successful vein solution clinic in the community where he manages patients with all presentations of varicose veins, large, small, spider veins – he is able to find a solution for all. Louis is a past vice president and honorary secretary of the Australian College of Phlebology.

Louis discusses how he manages patients at his busy outpatient clinic that has been providing services to patients in Melbourne for over 20 years using:

· Sclerotherapy

· Endovenous laser therapy

· Phlebectomy

· Application of glue

I enjoyed this conversation with Louis tremendously and hope you do too.

Useful references include:

- www.veinsolutionsmelbourne.com.au

- www.phlebology.com.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Vision Australia estimates there are 453,000 people in our country who are blind or have low vision. This number is predicted to grow to over 560,000 people by 2030. Low vision refers to the ability to see at only 6 meters what a normal vision could see at 60 meters. It also refers to a restricted peripheral vision narrower than 20 degrees in diameter. Such people need to use devices, technology and adaptive strategies to keep doing the things they enjoy. Conditions such as age-related macular degeneration, albinism, cataracts and glaucoma, are often responsible for low vision.

For those of us with relatively normal vision, it is easy to forget, ignore and misunderstand the challenges blind and vision-impaired people face daily. Apart from the obvious day-to-day challenges, blind and vision-impaired patients receiving medication have to cope with the difficulty of not seeing their prescription medication clearly, not recognising a pigmenting skin spot that may be melanoma or scaly lesion that could be neoplastic and have the significant emotional burden of isolation thrust upon them.

I was curious to understand some of these challenges by holding a conversation with the brilliant Mr. Murray Stewart. Murray is blind but has found his way to becoming a community leader, a podcaster, philanthropist, Myo therapist, athletics trainer for some of our future star athletes and managing director of Blind magic Communication. Murray Stewart hails from Australia’s’ red centre and is a true inspiration to all who meet him, please welcome him to the Podcast.  

References:

Murray Stewart: Bridgeovermurray@bigpond.com

www.visionaustralia.org

www.healthline.com 

Newfound freedom from lockdown in both Victoria and New South Wales will undoubtedly lead to greater COVID-19 exposure. Whilst widespread vaccination uptake has been achieved a significant number of adults and our children remain unvaccinated and vulnerable to the Delta strain. What can we expect from the health perspective for those exposed?

What are the health departments rules governing exposure? Is there a plan for rapid antigen testing in our community and what about version 2.0 of the vaccines?

Join me with Professor Erwin Loh, Chief Medical Officer from St Vincent’s health who has a superb grasp of world health data and is an expert in translating research evidence into best practice.

References:

https://au.linkedin.com › erwinlohWeb resultsProfessor Erwin Loh - Group Chief Medical Officer - LinkedIn

https://www.health.gov.au › newsCoronavirus (COVID-19) case numbers and statistics - Australian ...

https://www.worldometers.info › aus...Australia COVID - Coronavirus Cases - Worldometer

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

In this podcast we have a conversation with Gyu Lee who works with Victoria Alcohol and Drug Counselling Service as a harm reduction practitioner managing patients in the community who have developed addictions to both alcohol and drugs. Management techniques include close engagement with referred clients and an approach based on:

· Behavioural modification

· Pharmaceutical intervention

· Job rehabilitation

Whilst there has been a reduction in methamphetamine use in Australia from 2001 to 2019 use of cocaine and methylenedioxymethamphetamine (MDMA – ecstasy) have both increased. These drugs combined with alcohol addiction pose major social problems for our community. Please join me as we discuss these complex and confronting issues with Gyu Lee.

Useful references include:

- Drug and Alcohol Clinical Advisory Service (DACAS) Ph: 1800 812 804

- gyu.lee@windana.org.au

- PHARMACOTHERAPY NETWORK (EAST & SOUTH EAST REGION) for GPs http://a4pn.org.au/ email A4PN@semphn.org.au or call 03 8514 6600

- Medication Support and Recovery Service https://msrs.org.au/resources/gp-resources/

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.

Globus pharyngeus in an intermittent or persistent non-painful sensation of a lump or foreign body in the throat. First described 2,500 years ago by Hippocrates who thought the condition was secondary to pressure on the thyroid cartilage from contractions of the strap muscles of the neck, we now know that globus is a relatively common condition representing up to 4% of ENT referrals and may be seen in just less than half of healthy individuals at some point in time. Gastro-oesophageal reflux disease and hypertonicity of the upper oesophageal sphincter are very important contributors to the sensation.

In this episode we are joined today by experienced ENT surgeon Mr Adnan Safdar, Head of the ENT unit at Monash Health, who discusses:

· Globus as a presenting symptom

· Aetiologies

· Management strategies.

I hope you can join me on this podcast where Adnan provides a logical and practical approach to managing globus in clinical practice.

Useful references include:

- berwickent.com

- www.ncbi.nlm.nih.gov

- bjgp.org

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au

Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.